Medication Guide DULERA [dew-lair-ah] 100 mcg/5 mcg DULERA 200 mcg/5 mcg

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1 Medication Guide DULERA [dew-lair-ah] 100 mcg/5 mcg (mometasone furoate 100 mcg and formoterol fumarate dihydrate 5 mcg inhalation aerosol) DULERA 200 mcg/5 mcg (mometasone furoate 200 mcg and formoterol fumarate dihydrate 5 mcg inhalation aerosol) Read the Medication Guide that comes with DULERA before you start using it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your healthcare provider about your medical condition or treatment. What is the most important information I should know about DULERA? DULERA can cause serious side effects, including: 1. People with asthma who take long-acting beta 2 -adrenergic agonist (LABA) medicines such as formoterol (one of the medicines in DULERA), have an increased risk of death from asthma problems. It is not known whether mometasone furoate, the other medicine in DULERA, reduces the risk of death from asthma problems seen with formoterol. Call your healthcare provider if breathing problems worsen over time while using DULERA. You may need different treatment. Get emergency medical care if: o breathing problems worsen quickly, and o you use your rescue inhaler medicine, but it does not relieve your breathing problems. 2. DULERA should be used only if your healthcare provider decides that your asthma is not well controlled with a longterm asthma control medicine, such as an inhaled corticosteroid. 3. When your asthma is well controlled, your healthcare provider may tell you to stop taking DULERA. Your healthcare provider will decide if you can stop DULERA without loss of asthma control. Your healthcare provider may prescribe a different long-term asthma-control medicine for you, such as an inhaled corticosteroid. 4. Children and adolescents who take LABA medicines may have an increased risk of being hospitalized for asthma problems. What is DULERA? DULERA combines an inhaled corticosteroid medicine, mometasone furoate (the same medicine found in ASMANEX TWISTHALER), and a long-acting beta 2 -agonist medicine (LABA), formoterol (the same medicine found in FORADIL AEROLIZER ). Inhaled corticosteroids help to decrease inflammation in the lungs. Inflammation in the lungs can lead to asthma symptoms. LABA medicines are used in people with asthma. LABA medicines help the muscles around the airways in your lungs stay relaxed to prevent asthma symptoms, such as wheezing and shortness of breath. These symptoms can happen when the muscles around the airways tighten. This makes it hard to breathe. In severe cases, wheezing can stop your breathing and may lead to death if not treated right away. DULERA is used to control symptoms of asthma and prevent symptoms such as wheezing in people 12 years of age and older. DULERA should not be used as a rescue inhaler. DULERA contains formoterol (the same medicine found in FORADIL AEROLIZER). LABA medicines such as formoterol increase the risk of death from asthma problems. DULERA is not for children and adults with asthma who: are well controlled with an asthma-control medicine, such as a low to medium dose of an inhaled corticosteroid medicine 1

2 only need a rescue inhaler once in awhile It is not known if DULERA is safe and effective in children less than 12 years of age. Who should not use DULERA? Do not use DULERA: to treat sudden severe symptoms of asthma if you are allergic to any of the ingredients in DULERA. See the end of the Medication Guide for a list of ingredients in DULERA. What should I tell my healthcare provider before using DULERA? Tell your healthcare provider about all of your health conditions, including if you: have heart problems have high blood pressure have seizures have thyroid problems have diabetes have liver problems have osteoporosis have an immune system problem have eye problems such as increased pressure in the eye, glaucoma, or cataracts are allergic to any medicines are exposed to chickenpox or measles have any other medical problems are pregnant or planning to become pregnant. It is not known if DULERA may harm your unborn baby. are breastfeeding. It is not known if DULERA passes into your milk and if it can harm your baby. You and your healthcare provider should decide if you will take DULERA while breastfeeding. Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. DULERA and certain other medicines may interact with each other. This may cause serious side effects. Especially, tell your healthcare provider if you take antifungal medicines, such as ketoconazole, or anti-hiv medicines, such as ritonavir. The anti-hiv medicines NORVIR (ritonavir capsules) Soft Gelatin, NORVIR (ritonavir oral solution), and KALETRA (lopinavir/ritonavir) Tablets contain ritonavir. Know the medicines you take. Keep a list and show it to your healthcare provider and pharmacist each time you get a new medicine. How should I use DULERA? See the step-by-step instructions for using DULERA at the end of this Medication Guide. Do not use DULERA unless your healthcare provider has taught you and you understand everything. Ask your healthcare provider or pharmacist if you have any questions. Use DULERA exactly as prescribed. Do not use DULERA more often than prescribed. DULERA comes in 2 strengths. Your healthcare provider has prescribed the strength that is best for you. Note the differences between DULERA and your other inhaled medications, including the differences in prescribed use and physical appearance. DULERA should be taken every day as 2 puffs in the morning and 2 puffs in the evening. If you miss a dose of DULERA, skip your missed dose and take your next dose at your regular time. Do not take DULERA more often or use more puffs than you have been prescribed. While you are using DULERA 2 times each day, do not use other medicines that contain a long-acting beta 2 - agonist (LABA) for any reason. Ask your healthcare provider or pharmacist if any of your other medicines are LABA medicines. 2

3 If you take more DULERA than your healthcare provider has prescribed, get medical help right away if you have any unusual symptoms, such as problems breathing, palpitations, chest pain, increased heart rate, nervousness or shakiness. Do not change or stop using DULERA or other asthma medicines used to control or treat your breathing problems unless told to do so by your healthcare provider. Your healthcare provider will change your medicines as needed. DULERA does not relieve sudden asthma symptoms. Always have a rescue inhaler with you to treat sudden symptoms. Use your rescue inhaler if you have breathing problems between doses of DULERA. If you do not have a rescue inhaler, call your healthcare provider to have one prescribed for you. Rinse your mouth with water after each dose (2 puffs) of DULERA. This will help to lessen the chance of getting a yeast infection (thrush) in the mouth and throat. Do not spray DULERA in your eyes. If you accidentally get DULERA in your eyes, rinse your eyes with water and if redness or irritation continues, call your healthcare provider. Call your healthcare provider or get medical care right away if: o your breathing problems worsen with DULERA o you need to use your rescue inhaler more often than usual o your rescue inhaler does not work as well for you at relieving symptoms o you need to use 4 or more inhalations of your rescue inhaler for 2 or more days in a row o you use 1 whole canister of your rescue inhaler in 8 weeks time o your peak flow meter results decrease. Your healthcare provider will tell you the numbers that are right for you. o you have asthma and your symptoms do not improve after using DULERA regularly for 1 to 2 weeks What are the possible side effects of DULERA? DULERA can cause serious side effects, including: See What is the most important information I should know about DULERA? Thrush in the mouth and throat. You may develop a yeast infection (Candida albicans) in your mouth or throat. Rinse your mouth with water after using DULERA to help prevent an infection in your mouth or throat. Immune system effects and a higher chance for infections. Tell your healthcare provider about any signs of infection such as: o fever o feeling tired o pain o nausea o body aches o vomiting o chills Adrenal insufficiency. Adrenal insufficiency is a condition in which the adrenal glands do not make enough steroid hormones. This can happen when you stop taking oral corticosteroid medicines and start inhaled corticosteroid medicines. Increased wheezing right after taking DULERA. Always have a rescue inhaler with you to treat sudden wheezing. Serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms of a serious allergic reaction: o rash o hives o swelling of the face, mouth, and tongue o breathing problems 3

4 Using too much of a LABA medicine may cause: o chest pain o increased or decreased blood pressure o a fast and irregular heartbeat o headache o tremor o nervousness o dizziness o weakness o seizures Lower bone mineral density. This may be a problem for people who already have a higher chance for low bone density (osteoporosis). Slowed growth in children. A child s growth should be checked often. Eye problems including glaucoma and cataracts. You should have regular eye exams while using DULERA. Decreases in blood potassium levels (hypokalemia) Increases in blood sugar levels (hyperglycemia) The most common side effects of DULERA include: inflammation of the nose and throat (nasopharyngitis) inflammation of the sinuses (sinusitis) headache Tell your healthcare provider about any side effect that bothers you or that does not go away. These are not all the side effects with DULERA. Ask your healthcare provider or pharmacist for more information. Call your doctor for medical advice about side effects. You may report side effects to FDA at FDA You may also report side effects to Schering Corporation, a subsidiary of Merck & Co., Inc., at How do I store DULERA? Store DULERA at room temperature between 59 F to 86 F (15 C to 30 C). The contents of your DULERA are under pressure. Do not puncture. Do not use or store near heat or open flame. Storage above 120 F may cause the canister to burst. Do not throw container into fire or incinerator. Keep DULERA and all medicines out of the reach of children. General Information about DULERA Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use DULERA for a condition for which it was not prescribed. Do not give your DULERA to other people, even if they have the same condition. It may harm them. This Medication Guide summarizes the most important information about DULERA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about DULERA that was written for healthcare professionals. For more information about DULERA, go to or call What are the ingredients in DULERA? Active ingredients: mometasone furoate and formoterol fumarate dihydrate Inactive ingredient: hydrofluoroalkane (HFA-227), anhydrous alcohol and oleic acid 4

5 Patient Instructions for Use DULERA DULERA 100 mcg/5 mcg (mometasone furoate 100 mcg and formoterol fumarate dihydrate 5 mcg inhalation aerosol) DULERA 200 mcg/5 mcg (mometasone furoate 200 mcg and formoterol fumarate dihydrate 5 mcg inhalation aerosol) How to use your DULERA Before using your DULERA, read the complete instructions and use only as directed. The parts of your DULERA: There are 2 main parts to your DULERA inhaler the metal canister that holds the medicine and the blue plastic actuator that sprays the medicine from the canister. The inhaler also has a cap that covers the mouthpiece of the actuator (see Figure 1). The inhaler contains 120 actuations (puffs). Figure 1 The inhaler comes with dose counter located on the plastic actuator. See Figure 1. The counter display will show the number of actuations (puffs) of medicine remaining. The dose counter will initially display 124 actuations remaining. Each time you press the canister, a puff of medicine is released and the counter will count down by 1. The counter will stop counting at 0. You should not remove the canister from the actuator because reinsertion may cause the counter to count down by 1 and discharge a puff. Use the DULERA canister only with the actuator supplied with the product. Do not use parts of the DULERA inhaler with parts from any other inhalation medicine. Before using your DULERA: Remove the cap from the mouthpiece of the actuator (see Figure 2). Check the mouthpiece for objects before use. Make sure the canister is fully inserted into the actuator. 5

6 Figure 2 Priming your DULERA Inhaler: Before you use DULERA for the first time, you must prime the inhaler. 1. To prime the inhaler, hold it in the upright position and release 4 actuations (puffs) into the air, away from your face. 2. Shake the inhaler well before each of the priming actuations. After priming 4 times, the dose counter should read If you do not use your DULERA for more than 5 days, you will need to prime it again before use. Using your DULERA 4. Remove the cap from the mouthpiece of the actuator (see Figure 2). Check the mouthpiece for objects before use. Make sure the canister is fully inserted into the actuator. 5. Shake the inhaler well before each use. 6. Breathe out as fully as you comfortably can through your mouth. Push out as much air from your lungs as possible. Hold the inhaler in the upright position and place the mouthpiece into your mouth (see Figure 3). Close your lips around the mouthpiece. Figure 3 7. Take a deep breath (inhale) in slowly through your mouth. While doing this, press down firmly and fully on the top of the canister until it stops moving in the actuator. Take your finger off the canister. 8. When you have finished breathing in, hold your breath as long as you comfortably can, up to 10 seconds. Then remove the inhaler from your mouth and breathe out through your nose, while keeping your lips closed. 9. Wait at least 30 seconds, to take your second puff of DULERA. 10. Shake the inhaler well again and repeat steps 6 through 8 before you take your second puff of DULERA. 6

7 After using your DULERA inhaler: 11. Replace the cap over the mouthpiece right away after use. 12. After you finish taking DULERA (2 puffs), rinse your mouth with water. Reading the counter The dose counter identifies the number of inhalations (puffs) left in your inhaler. The counter will count down each time you release a puff of medicine (either when preparing your DULERA inhaler for use or when taking the medicine). When to replace your DULERA: It is important that you pay attention to the number of inhalations (puffs) left in your DULERA inhaler by reading the counter. When the counter reads 20, you should refill your prescription or ask your healthcare provider if you need a new prescription for DULERA. Throw away DULERA after the counter reaches 0, indicating that you have used the number of actuations on the product label and box. Your inhaler may not feel empty and it may continue to operate, but you will not get the right amount of medicine if you keep using it. Never try to change the numbers on the counter or remove the counter from the actuator. Do not use the inhaler after the expiration date. How do I store DULERA? Store DULERA at room temperature between 59 F to 86 F (15 C to 30 C). The contents of your DULERA canister are under pressure. Do not puncture or throw the canister into a fire or incinerator. Do not use or store it near heat or open flame. Storage above 120ºF (50 C) may cause the canister to burst. Keep DULERA and all medicines out of the reach of children. How to clean your DULERA: The mouthpiece should be cleaned using a dry wipe after every 7 days of use. Routine cleaning instructions: Remove the cap off the mouthpiece. Wipe the inside and outside surfaces of the actuator mouthpiece with a clean, dry, lint-free tissue or cloth. Put the cap back on the mouthpiece after cleaning. Do not attempt to unblock the actuator with a sharp object, such as a pin. Do not wash or put any parts of your inhaler in water. 7

8 Manufactured by: 3M Health Care Ltd., Loughborough, United Kingdom. Issued August 2011 This Medication Guide has been approved by the U.S. Food and Drug Administration. Copyright 2010 Schering Corporation, a subsidiary of Merck & Co., Inc. All rights reserved The trademarks depicted in this piece are owned by their respective companies. FORADIL is a registered trademark of Astellas Pharma Inc. AEROLIZER is a registered trademark of Novartis AG. NORVIR and KALETRA are registered trademarks of Abbott Laboratories T 8